Publication:

Bacterial infections in cirrhosis - does standard empirical therapy need a rethink?

Background Patients with cirrhosis not only have a higher incidence and a greater severity of infections but infections increase the mortality and morbidity in cirrhosis. Third-generation cephalosporins and quinolones are currently the most commonly recommended first-line empirical therapy in most infections. This study was conducted to study the bacterial etiology, susceptibility of these organisms to these commonly used antibiotics.

Methods All patients of cirrhosis of liver admitted to a tertiary care centre underwent cultures from blood, urine and ascitic fluid and the incidence of infection was calculated. Sensitivity pattern of organisms to third generation cephalosporins and quinolones were studied.

Results A total of 150 patients were included in the study and 58 (37.8%) of them had one or more infections. Spontaneous bacterial peritonitis was the most common infection noted and gram-negative bacilli (E. coli) were the commonest organisms isolated. The overall response rate to quinolones and third generation cephalosporin’s was only 47%.

Conclusions Increasing use of antibiotics in empirical role has increased resistance to commonly used antibiotics. Empirical therapy should be decided based upon local epidemiological patterns and the same cannot be generalized.